Clinical efficacy of preoperative SIB-IMRT for 26 cases of locally-advanced low rectal cancer
10.3760/cma.j.issn.1004-4221.2018.10.007
- VernacularTitle:26例低位局部进展期直肠癌术前加量IMRT临床观察
- Author:
Qiteng LIU
1
,
2
;
Linchun FENG
;
Baoqing JIA
;
Xiaohui DU
;
Hongyi LIU
;
Guanghai DAI
;
Jing CHEN
;
Yongqiang YANG
;
Ke WEN
;
Yunlai WANG
;
Tao YANG
;
Yuyan GAO
Author Information
1. 100853 北京,解放军医学院肿瘤学系解放军总医院放疗科
2. 首都医科大学附属北京潞河医院放疗科
- Keywords:
Rectal neoplasm;
Anal neoplasm;
Neoadjuvant chemoradiotherapy;
Sphincter-preserving surgery
- From:
Chinese Journal of Radiation Oncology
2018;27(10):906-910
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the feasibility and clinical efficacy of preoperative simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) combined with neoadjuvant chemotherapy of capecitabine in patients with locally-advanced low rectal cancer.Methods Between 2015 and 2016,26 patients admitted to 301 Hospital who were diagnosed with locally-advanced low rectal cancer,which was located within 5 cm from the anal verge,were enrolled in this investigation.Dose fractionation pattern was delivered:58.75 Gy in 25 fractions (2.35 Gy/fraction) for rectal cancer and lymph node metastasis and 50 Gy in 25 fractions for the pelvic lymphatic drainage area and simultaneously combined with capecitabine chemotherapy (825 mg/m2,bid d 1-5 weekly).One cycle of capecitabine (1 250 mg/m2,twice daily,d 1-14)was given at one week after the completion of chemoradiotherapy (CRT).Total mesorectal excision (TME)was performed at 6 to 8 weeks after the completion of CRT.The primary endpoints included pathological complete response rate (ypCR) and sphincter-preserving rate.The secondary endpoints included acute toxicity,tumor downstaging rate and postoperative complications.Results Twenty-six patients successfully completed neoadjuvant CRT,25 of them underwent surgical resection and one patient failed to receive surgery due to pxrianal edema.Postoperative ypCR rate was 32％ (8/25),the sphincter-preserving rate was 60％ (15/25),the tumor downstaging rate was 92％ (23/25) and the R0 resection rate was 100％.During the period of CRT,grade 1 and 2 adverse events occurred in 24 patients,grade 3 radiation dermatitis was noted in 2 cases.No ≥ grade 4 acute adverse event was observed.Postoperative complications included ureteral injury in one case and intestinal obstruction in one patient.Conclusions Preoperative SIB-IMRT combined with neoadjuvant chemotherapy of capecitabine is a feasible and safe treatment for patients with locallyadvanced low rectal cancer,which yields expected ypCR rate,R0 resection rate and sphincter-preserving rate.Nevertheless,the long-term clinical benefits remain to be elucidated.Clinical Trial Registry Chinese Clinical Trial Registry,registration number:ChiCTR-ONC-12002387.
